What are the functions of respiratory system
- Helps gas exchange between air + blood
- Protects body from dehydration, temp fluctionations, entrance of pathogen
- Helps speech and sound function
- Homeostasis - CO2 regulation
Visceral layer vs parietal layer
Visceral (inner) - adhere to lung surface
Parietal ( outer) - adhere to thoracic wall
What are the ways I’m which we regulate respiration
- Neurological regulation - medulla/pons in brain controls respiration
- Chemical reaction - chemoreceptors monitor pH, PaCo2, PaO2
- Mechanic reaction - contraction of diaphragm and external intercostal muscles
How does the neurological regulation control respiratory
Through the medulla and pons in the brain
Medulla center controls dorsal group (inspiration) and ventral group (expiration) = send impulse to diaphragm/intercostal muscles and receivers impulses fro, chemoreceptors
Pons center controls pneumotaxic centre (rate and depth)
How does chemical regulation control respiration
Chemoreceptors monitor pH, PaCO2, and PaO2 of arterial blood
- peripheral chemoreceptors are in aortic and carotid bodies which respond to change in blood CO2 + O2 and BP to rise rate and depth of breathing
- central chemoreceptors located in medulla and monitor blood by pH when there increases PaCO2 ventilation increases and causes CO2 to go down.
How does mechanical regulation control respiratory
Respiratory center stimulates ventilation —> impulse sent to phrenic nerve —> stimulate diaphragm to contract/move down/intercostal muscles help ribs move up and out. —> lungs expand, pressure sin lungs become negative to atmosphere - air moves in. —> chest relaxes -diaphragm moves upwards = pressure in lungs become positive to atmosphere = air out
What are 4 factors that affect mechanics of ventilation
- Alveolar surface tension and ventilation (surfactant to prevent alveoli from collapse)
- Elastic properties of the lung and chest will (depends on collagen/elastic fibres) —> elastic recoil: tendency for lungs to return to resting. compliance - measure of lung and chest distendability
- Airway resistance (increased resistance as radius of air passage decreases)
- Work of breathing
What is inspiratory reserve volume Tidal volume Residual volume Expiratory reserve volume Vital capacity
inspiratory reserve volume - amount of air that can be inhaled forceably
Tidal volume - air moved in and out of lungs on normal breath
Residual volume- volume of air that remains in lungs after forced expiration
Expiratory reserve volume - volume of air that can be forced out
Vital capacity - sum of tidal volume. Inspiratory reserve and expiratory reserve
What is asthma
Heterogenous disease characterised by chronic airway inflammation, with reversible bronchoconstriction, oedema of airways and mucous hyper secretion.
Pathophysiology of asthma
Sensitisation phase
- initial exposure to alleged
- specific IGE antibodies produced to attack foreign substance which bind to mast cells on lung tissue
Re-exposure
- re-exposure to allergen = it will bind to IGE
- IGE activated and causes rupture of the mast cells (degranulation)
- releases chemical mediators
- histamine/prostaglandins = vasodilation and increases permeability leading to oedema of airways
- leukotrines = bronchoconstriction
- platelet activating factor = mucous production
Causes of asthma and difference between atopic and non-atopic
Variety of triggers - genetic / environment/ lifestyle / medication / dietary / cleaning products / allergies
Atopic (extrinsic) triggered by environemnt
Non-atopic (intrinsic) triggered by non-environment (exercise stress)
Clinical manifestations of asthma
Chest tightness, cough, dyspnoea, wheezing, anxiety, tachypneoa, tachycardia, accessory , muscle use
Complications of asthma
Status asthmaticus - exacerbation of airway = odemea
Respiratory infection - excessive cough can break muscles lunging of airway track
Atelectasis - collapse of lung resulted from block airway ‘ abnormal surfactant
Pneumothorax - air in pleural space collapsing lung
cor pulmonale - dysfunction of lung leading to dysfunction of heart
Uncontrolled asthma - slow decline in lung function as they age increasing asthma attacks leading to respiratory failure
Nursing management plan for asthma
Assessment - collect cues/info, health history, physical exam, diagnosis criteria ( peek expiratory flow rate/history/arterial blood gas/clinical manifestations)
Plan - consider the patient and establish patients goals
Nursing diagnosis
- ineffective breathing pattern related to swelling and spasms of bronchial tube in response to allergy/stress/infection
- inneffective airway clearance related to bronchospasms, excessive mucous production and ineffective cough
- anxiety/fear related to respiratory distress
- knowledge deficit related to disease condition, medications, unfamiliar with resources
Goals
- control symtpoms / prevent attacks
- maintain airway during attack - bronchodilator
- maximise compliance/minimise airway resistance / WOB
Ongoing
- develop a my asthma action plan
- patients level of understanding
- extra resources
What is pneumonia
Is an inflammation of lung parenchyma which causes alteration in gas exchange
Pathophysiology of pneumonia
- Trauma or pathogen entry
- Triggers inflammatory response - BV dilate (capillary leak) —> blood cells move out of BV and into lungs to fight pathogen
- Leads to debris build up = alveolar oedema + vascular congestion
- Further inflammation so release of inflammatory mediators
- Damage to cells = accumulate cause debris and exudate = consolidation = hypoxia
Causes of pneumonia
Aspiration of gastric content or bacterial flora
Inhalation of contaminants
Contamination from systemic circulation
Risk factors of pneumonia
Advanced age Compromised immunity Underlying lung disease/cardiac /liver disease Chest trauma Smoking Malnutrition
Clinical manifestations and complications of pneumonia
Clinical features - fever, anoerexia, fatigue, cough, purulent sputum, pleuretic chest pain, dyspnoea
Complications - hypoxia, pleural empyema, pneumonic shock, pleural effusion, septic shock
Clinical diagnosis of pneumonia
Full history Physical exam Oxygen sat <95 = impaired gas exchange Sputum culture - to identify right antibiotic Chest X ray for diagnosis Blood test / FBC (high or low WBC)
5 classifications of pneumonia
- CAP - community aquired pneumonia
- HAP - hospital aquired pneumonia
- VAP - ventilated aquired pneumonia
- Pneumonia in the immune compromised patient
- Typical/atypical - typical caused by bacteria and atypical caused by virus
Management of pneumonia
Improve oxygen
Fluid balance - IV fluid for dehydration/low BP
Empirical antibiotics
Treat symtpoms - pain relief, antiemetic antipyretic
Prevent - vaccines
